Skotnicki S H, Schulte B P, Leyten Q H, Tacke T J, Arntz I E
Department of Thoracic and Cardiovascular Surgery, University Hospital St. Radboud, Nijmegen, The Netherlands.
Eur J Cardiothorac Surg. 1987;1(1):11-5. doi: 10.1016/s1010-7940(87)80006-4.
The clinical significance of the presence of carotid bruit was evaluated in 643 patients who underwent coronary artery surgery alone or in combination with other cardiac procedures. Carotid bruit was heard in 31 patients (5%) who were neurologically asymptomatic. All of them underwent coronary artery surgery without additional carotid procedures, and none of them developed neurological deficits during the postoperative period. Of the remaining 612 patients, 18 were identified as having a history of focal neurological disorders, and 9 of them had carotid bruit. All were analyzed by means of noninvasive tests and angiography. Five underwent carotid endarterectomy prior to (2 patients) and simultaneously with (3 patients) a coronary bypass procedure. Seven patients developed neurological deficits postoperatively. Most of the deficits were not lateralized or focal but diffuse, which suggests global cerebral ischemia not related to carotid disease. Only 1 patient had proven carotid obstructive disease and underwent successful carotid thrombendarterectomy 10 days postoperatively. This study, although based on limited material, supports the hypothesis that patients with asymptomatic carotid bruit can safely undergo coronary artery surgery. In the group of patients without neurological symptomatology, postoperative neurological deficits were rarely caused by occlusive carotid disease. However, patients with asymptomatic carotid bruit should be closely followed with the goal of identifying those who are at risk of developing neurological deficits.
对643例单独接受冠状动脉手术或同时接受其他心脏手术的患者，评估了颈动脉杂音的临床意义。在31例（5%）无神经系统症状的患者中听到了颈动脉杂音。他们均未接受额外的颈动脉手术而仅接受了冠状动脉手术，且术后均未出现神经功能缺损。在其余612例患者中，18例有局灶性神经系统疾病史，其中9例有颈动脉杂音。所有患者均通过无创检查和血管造影进行分析。5例患者在冠状动脉搭桥手术前（2例）和同时（3例）接受了颈动脉内膜切除术。7例患者术后出现神经功能缺损。大多数缺损并非局限于一侧或某一部位，而是弥漫性的，这提示与颈动脉疾病无关的全脑缺血。仅1例患者证实有颈动脉阻塞性疾病，并在术后10天成功进行了颈动脉血栓内膜切除术。本研究虽然基于有限的病例资料，但支持了无症状颈动脉杂音患者可安全接受冠状动脉手术这一假说。在无神经系统症状的患者组中，术后神经功能缺损很少由颈动脉闭塞性疾病引起。然而，对无症状颈动脉杂音患者应密切随访，目的是识别那些有发生神经功能缺损风险的患者。
